A 2-year-old child develops fever, seizures, and encephalopathy. CSF analysis shows: glucose 15 mg/dL (blood glucose 90 mg/dL), protein 200 mg/dL, and 400 cells/µL predominantly lymphocytes. India ink stain is negative. What is the MOST appropriate empirical treatment?
- A IV acyclovir 10 mg/kg every 8 hours
- B IV ceftriaxone + IV acyclovir ✓
- C IV amphotericin B + oral flucytosine
- D IV ceftriaxone alone
Explanation
In a child with acute encephalitis (fever, seizures, encephalopathy) and CSF showing lymphocytic pleocytosis with low glucose (CSF:blood ratio 0.17, indicating possible bacterial or viral etiology), empirical treatment must cover BOTH bacterial meningitis (ceftriaxone covers most common bacterial pathogens) AND herpes simplex encephalitis (IV acyclovir). HSE can mimic bacterial meningitis with low CSF glucose occasionally. India ink negative makes cryptococcal meningitis less likely. Starting both antibiotics AND acyclovir simultaneously is the standard empirical approach until specific diagnosis is confirmed by PCR and cultures.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.